Wed January 15, 2014

After Checking Blood Pressure, Kiosks Give Sales Leads To Insurers

SoloHealth owns 3,500 health screening kiosks like this one in San Francisco. In some states, the company sells customer contact information to insurers.

April Dembosky

Those machines in drugstores and supermarkets that let people check their blood pressure also may be selling people's contact information to insurance companies trolling for new customers.

One of these kiosks sits in Aisle 10 of a Safeway in a city near San Francisco. Sitting down at the machine is like slipping into the cockpit of a 1980s arcade game. There are a big plastic seat and footrest for measuring weight and body mass index, a window for testing vision, and a blood pressure cuff. The kiosks don't charge people for the blood pressure measurement.

"Make sure the cuff comes up above your elbow," says an attractive brunette on-screen. She is wearing a white lab coat and she asks a lot of personal questions like, "Do you have a blood relative who was told they have a heart problem?" And, "During the past 30 days, how many days have you felt sad or depressed?"

The machines are owned by a company based near Atlanta called SoloHealth. It started installing the kiosks in Wal-Mart stores and other retail stores in 2008 to give people a way to keep better track of their health. Today there are more than 3,500 SoloHealth stations across the U.S., and the company plans to install an additional 1,500 this year.

SoloHealth first made money by selling ads for pharmacy items displayed near the kiosks. But it has happened on a new business model: The data it collects are suddenly very valuable to health insurance companies.

"As much as we've moved to the market, the market has really moved to us," says Bart Foster, CEO of SoloHealth. "We're able to provide much more detailed information than the health plans even know what to do with today."

In this case, it means selling information about people who have used SoloHealth kiosks. For now, SoloHealth is selling names, email addresses and phone numbers to insurers who want to market health plans directly to consumers.

Now that most Americans are required to have health coverage by March 31 or pay a penalty, insurers are looking for new ways of finding potential customers, and competing with each other to get their attention.

Anthem Blue Cross is one of them. It brokered an exclusive agreement with SoloHealth to be the sole insurance company featured on kiosks throughout California.

"We know that engaging consumers early and engaging them with our messaging helps improve the chances of them choosing Anthem as their health plan," says spokesman Darrel Ng.

As a part of that strategy, SoloHealth added a new service to its machines in October offering help with understanding the Affordable Care Act.

"If you would like to learn more about the upcoming changes to the health care system and how they affect you," a male voice now says to visitors at the kiosks, "select the 'continue' button at the bottom of the screen."

A drawing of a doctor with a stethoscope around his neck flashes and the voice-over says, "We can have an experienced professional reach out to help you find the plan that meets your specific needs."

But what the friendly voice doesn't make clear is that the "experienced professional" is not a doctor or SoloHealth representative, but an insurance rep. That is only explained after the customer enters his or her name and email.

Privacy advocates say this is misleading.

"Consumers have every reason to be shocked this is happening," says Pam Dixon, executive director of the nonprofit World Privacy Forum, based in San Diego.

She says most consumers don't understand that their information is being sold. While there is a two-page health privacy disclosure on the machines, it can only be viewed by clicking a blue button at the bottom of the screen. Whether customers read it or not, they agree to all the terms when they hit a separate green button. Dixon says that's not good enough.

"The fact that they're not being told in a clear, conspicuous and prominent manner is problematic," she says.

SoloHealth says it is reviewing the customer experience of its kiosks.

After partnering with insurance companies, SoloHealth has made another recent change. Until a couple of weeks ago, the company's comprehensive privacy policy — governing what the company can do with the data it collects — wasn't on the machine. There was a Web address provided, but since there was no Internet connection at the kiosk, there was no way to read it.

At first, SoloHealth said it was too cumbersome to scroll through the information on the small kiosk screen. But then, in mid-December, the company added the full policy to its machines. SoloHealth said the change was made to improve transparency.

"We work with retail partners, our attorneys and our corporate sponsors to make sure that we're totally buttoned up," says Foster, SoloHealth's CEO. "We have a number of very large companies that have looked at this and are very comfortable with where we are."

But some consumers are uncomfortable with it. Stacey Winn has been using the kiosk at her local supermarket for the past six months to track her blood pressure. She doesn't remember ever seeing a privacy policy, even when she visited late last month after it was added. What she noticed for the first time were ads for a health insurance plan. Now she feels uneasy about her blood pressure records, weight, age and ethnicity being stored in SoloHealth's database.

"I wonder now what they're doing with that information when I hadn't really wondered that before," she says. "There's a saying that if a service is offered for free then you're actually the product that's being sold, and I think that this is turning into an example of that."

This story is part of a reporting partnership with NPR and Kaiser Health News.

America's uninsured have until the end of March to enroll in health plans under the Affordable Care Act, and insurance companies are eager to sign them up. Some are finding new customers through health screening machines at local stores, and that's making privacy experts nervous.

From member station KQED in San Francisco, reporter April Dembosky explains.

APRIL DEMBOSKY, BYLINE: In a grocery store near San Francisco, there is a tall health screening kiosk next to the shelves of antacid and cold medicine. Sitting down at the machine is like slipping into the cockpit of a 1980s arcade game. There's a big plastic seat for measuring weight, a window for testing vision and a blood pressure cuff.

UNIDENTIFIED WOMAN: Please sit as still as possible when this test is in progress.

DEMBOSKY: The guide for the test is an attractive brunette wearing a white lab coat. She asks a lot of questions

UNIDENTIFIED WOMAN: How many servings of vegetables do you eat per day? Do you have a blood relative who was told they have a heart problem? During the past 30 days, about how many days have you felt sad or depressed?

DEMBOSKY: The machines are owned by a Georgia company called SoloHealth. It started installing the kiosks in Walmart and other retail stores in 2008. Today, there are more than 3500 SoloHealth stations across the U.S. And 130,000 people use one every day free of charge.

SoloHealth first made money by selling ads for pharmacy items displayed near the machines. But in the era of health care reform, the company happened upon a new business model. All the details it's collected from people who use the machines are suddenly very valuable to health insurance companies.

BART FOSTER: As much as we've moved to the market, the market has really moved to us.

DEMBOSKY: Bart Foster is the CEO of SoloHealth.

FOSTER: We're able to provide much more detailed information than the health plans even really know what to do with today.

DEMBOSKY: The company is selling names, email addresses and phone numbers to insurers who want to market health plans directly to consumers, now that most Americans are required to have insurance by March 31st.

Darrel Ng is a spokesperson for Anthem Blue Cross. That insurer brokered an exclusive agreement with SoloHealth to be featured on machines in California.

DARREL NG: We know that engaging consumers early and engaging them with our messaging, helps improve the chances of them choosing Anthem as their health plan.

DEMBOSKY: Other insurers have similar agreements in other states. Here's the catch: The new alliances aren't made clear to people who use the machines. What they see is a drawing of a doctor with a stethoscope around his neck, offering help with the Affordable Care Act.

UNIDENTIFIED MAN: We can have an experienced professional reach out to help you find the plan that fits your specific needs.

DEMBOSKY: But the friendly voice doesn't make clear that the experienced professional is actually an insurance rep. That is explained after the person enters their name and email. Privacy advocates say this is misleading.

Pam Dixon is the executive director of the World Privacy Forum.

PAM DIXON: Consumers have every reason to be shocked that this is happening.

DEMBOSKY: She says most consumers don't understand that their information is being sold. There is a health privacy disclosure, but she says it's too easy to miss.

DIXON: The fact that they're not being told about it in a very clear and conspicuous and prominent manner is problematic.

FOSTER: So we work with our retail partners, our attorneys, and our corporate sponsors to make sure that we're totally buttoned up.

DEMBOSKY: Yet until recently, the company's comprehensive privacy policy wasn't on the machine at all. It was only online. The company added the full policy to its machines a few weeks ago, it said, to improve transparency.

The experience is still unsettling for some consumers. Stacey Winn has been using the kiosk at her local supermarket for the last six months. She doesn't remember ever seeing a privacy policy. What she did notice for the first time last month, were ads for a health insurance plan.

STACEY WINN: I wonder now what they're doing with that information when I hadn't really wondered that before.

DEMBOSKY: Now she feels uneasy about her health details being stored in the company's database.

WINN: You know, there's this saying that if a service is offered for free then you're actually the product that's being sold, and I think that this is kind of turning into an example of that.

DEMBOSKY: SoloHealth says it is reviewing the customer experience of machines, for clarity. At the same time, the company is expanding. It plans to install another 1,500 machines nationwide this year and deepen its relationships with insurers.

For NPR News, I'm April Dembosky in San Francisco.

BLOCK: This story is part of a partnership with NPR and Kaiser Health News.